Provider Demographics
NPI:1568438505
Name:MOSELEY, JAMES B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4646 POPLAR AVE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4426
Mailing Address - Country:US
Mailing Address - Phone:901-268-5707
Mailing Address - Fax:901-374-0924
Practice Address - Street 1:4646 POPLAR AVE
Practice Address - Street 2:SUITE 317
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4426
Practice Address - Country:US
Practice Address - Phone:901-268-5707
Practice Address - Fax:901-374-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE35492084P0800X
TNMD131842084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134589726Medicaid
AR134589726Medicaid
B01378Medicare UPIN